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Quality of Non–Breast Cancer Health Maintenance Among Elderly Breast Cancer Survivors

Craig C. Earle, Harold J. Burstein, Eric P. Winer, Jane C. Weeks

From the Division of Population Sciences, Center for Outcomes and Policy Research, Breast Oncology Center, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA.

Address reprint requests to Craig C. Earle, MD, Center for Outcomes and Policy Research, Dana-Farber Cancer Center, 44 Binney St., Boston, MA, 02115; email: craig_earle{at}dfci.harvard.edu.

Purpose: To assess the quality of preventive health care, the role of health care participation, and the patient and provider characteristics associated with high-quality care for breast cancer survivors.

Methods: We analyzed the 1997 to 1998 Medicare data of elderly women who were diagnosed with nonmetastatic breast cancer in 1991 or 1992 while living in a Survival, Epidemiology, and End Results (SEER) tumor registry area and who survived to the end of 1998 without evidence of cancer recurrence. Controls were matched for age, race, and geographic location.

Results: The 5,965 breast cancer survivors received more preventive services (influenza vaccination, lipid testing, cervical and colon screening, and bone densitometry) than matched controls. Among both groups, those who were younger, non–African-American, of higher socioeconomic status, living in urban areas, and receiving care in a teaching center were most likely to receive high-quality health maintenance. Those survivors who continued to see oncology specialists were more likely to receive appropriate follow-up mammography for their cancer, but those who were monitored by primary care physicians were more likely to receive all other non–cancer-related preventive services. Those who saw both types of practitioners received more of both types of services. When the control group was restricted only to women actively undergoing mammographic screening before the study period, receipt of preventive services was similar.

Conclusion: Breast cancer survivors receive high-quality preventive services, but disparities on the basis of nonmedical factors still exist. Cancer follow-up may provide regular contact with the health system, maximizing the likelihood of receiving appropriate general medical care.

Supported by grants from the Massachusetts Department of Public Health (MDPH 34080066068) and the Friends of the Dana-Farber Cancer Institute.

Presented at the thirty-seventh annual meeting of the American Society of Clinical Oncology, May 12–15, 2001, San Francisco, CA.

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